<?php $this->load->view("layout/header_data_form");?>

<?php $this->load->view('layout/logo');?>

<div id="wrap">
  <form id="form1" name="form1" method="post" action="">
    <table border="0" cellpadding="5" cellspacing="0">
      <tr>
        <td width="500" align="left" valign="top"><table border="0" cellpadding="7" cellspacing="0">
          <tr>
            <td align="right"><strong>Yearly Income:</strong></td>
            <td><input name="textfield5" value="<?php echo ($row ? $row["yearly_income"] : '');?>" type="text" class="field" id="textfield5" size="40" /></td>
          </tr>
          <tr>
            <td align="right"><strong>% to Protect:</strong></td>
            <td><input name="textfield2" value="<?php echo ($row ? $row["percent_protection"]  : '');?>" type="text" class="field" id="textfield2" size="40" /></td>
          </tr>
          <tr>
            <td align="right"><strong>Number of Years to Protect:</strong></td>
            <td><input name="textfield6" value="<?php echo ($row ? $row["number_year_protect"]  : '');?>" type="text" class="field" id="textfield6" size="40" /></td>
          </tr>
          <tr>
            <td align="right"><strong>Lump Sum for Immediate<br />
              Treatement:</strong></td>
            <td><input name="textfield7" value="<?php echo ($row ? $row["lump_sum"] : '');?>" type="text" class="field" id="textfield7" size="40" />            </td>
          </tr>
          <!--<tr>
            <td align="right"><strong>Inflation:</strong></td>
            <td><input name="textfield" type="text" class="field" id="textfield" size="40" /></td>
          </tr>-->
          <tr>
            <td align="right">&nbsp;</td>
            <td>
            <input type="hidden" name="submit" value="0"/>
            <input type="submit" class="large button green" name="btnCalculate" value="Calculate"/></td>
          </tr>

        </table>
        </td>
      </tr>
      <tr>
        <td align="left" valign="top">
         <div id="graph" style="display:block;">
            <br />
            
            <br />
 			<?php $this->load->view('protection_against/chart');?>
            <table border="0" cellpadding="7" cellspacing="0">
              <tr>
                <td align="left"><strong>Explanation:</strong></td>
              </tr>
              <tr>
                <td align="left"><textarea name="textfield3" cols="60" rows="6" class="field" id="textfield3"><?php echo($row && isset($row['explanation']) ? $row['explanation'] : '');?></textarea></td>
              </tr>
              <tr>
                <td align="right">
                <input type="hidden" name="submit" value="1"/>
                <input name="btnSubmit" type="submit" class="large button red" value="Submit" />
                </td>
              </tr>
          </table>

		<br />
		</div>
		</form>
        
        </td>
      </tr>
      <tr>
        <td align="left" valign="top"><a href="JavaScript:window.close();"><img src="<?php echo img_link('cwindow.jpg');?>" alt="Close Window" width="82" height="15" border="0" /></a></td>
      </tr>
    </table>
  
  
  
</div>
<?php $this->load->view("layout/footer_data_form");?>